Does everyone use an explorer for caries detection?

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One of my faculty said in a lecture that some schools don't allow explorers to be in their general exam kits. The reason, she cites, is that an untrained student can create cavitated lesions with explorers if you poke too hard.

Does anyone's school not allow them to use explorers?

 

[jeffity]

One of my faculty said in a lecture that some schools don't allow explorers to be in their general exam kits. The reason, she cites, is that an untrained student can create cavitated lesions with explorers if you poke too hard.

Does anyone's school not allow them to use explorers?

I think the concept is widely known by now. But I haven't really heard of schools actually withholding an explorer for that reason. At this stage, they just have to trust us with the big-boy, sharp-nosed scissors. May as well put a governor on the handpiece too.

 

[Maka]

I mean....don't go repeatedly jamming it into pits or fissures that MIGHT be carious...if it seems hard with a little pressure, no problem right? Also look at your xray, dep on the surface.. If you're unsure, write a note in the chart to watch it. In a pt with normal caries risk, it's not like it's going to develop into a huge lesion in a few weeks.

We use explorers a ton to check for caries once you open the tooth up - however I like using the spoon and hatchet as my final intra-tooth test.

 

[Duriel]

I've been taught to never use an explorer to look for pit and fissure caries. Here are the reasons:

1) study's have shown this method to be completely inaccurate. The 'stick' from the explorer will be mostly from the anatomy of the uncoalesced grooves.

2) You are risking fracturing the enamel jabbing the explorer into it

3) you are most likely just transferring bacteria from groove to groove. Potentially infective an uninfected groove.

 

[SoulPower]

3) you are most likely just transferring bacteria from groove to groove. Potentially infective an uninfected groove.

would you not do this with any other type of instrument? I have heard of using a perioprobe for checking carious lesions. It seems that no method is full proof for actual caries detection atm.

 

[Duriel]

would you not do this with any other type of instrument? I have heard of using a perioprobe for checking carious lesions. It seems that no method is full proof for actual caries detection atm.

I think the more important thing is that the explorer isn't really doing anything useful when used for caries detection.

Here is a reference:
Caries Research

 

[Duriel]

More research, that I dont have the time to find links for (I should be studying for the 2 tests I have on monday 👎):

• Al-Sehaibany 1996
  Lussi 1991
  Lussi 1993
  Newbrun 1993
  Hintze 1993
  Penning 1992
  McComb 2001
  

 Explorer detects correctly only 25% of the time
Explorer no better than visual exam
Using an explorer has NOT been shown to improve the accuracy of caries diagnosis.
A catch with the explorer due to non-carious anatomical features of pits and fissures is common

 

[jay47]

More research, that I dont have the time to find links for (I should be studying for the 2 tests I have on monday 👎):

• Al-Sehaibany 1996
  Lussi 1991
  Lussi 1993
  Newbrun 1993
  Hintze 1993
  Penning 1992
  McComb 2001
  

 Explorer detects correctly only 25% of the time
Explorer no better than visual exam
Using an explorer has NOT been shown to improve the accuracy of caries diagnosis.
A catch with the explorer due to non-carious anatomical features of pits and fissures is common

I'd say 99% of the time, drying the tooth and using your eyes is the best way to go, sometimes I'll want to stick and explorer in there and see what's going on.

 

[goffdent]

There is another type of detection and classification= ICDAS

http://www.icdas.org/

 

[Msmouth]

Oh wow this is news to me! I've been an RDH for years and never heard/read this before. Every doctor I work for uses an explorer for caries detection. I work in one office regularly and have temped in countless offices....this is what all dentists do. I'm sure I'll run into more surprises once I begin dental school.

 

[Odontos2015]

We are taught that the most accurate method of detection is visual+radiographic. Some profs swear by tug-back method, others say it's inaccurate. I'm guessing it would be more reliable for smooth surface caries detection.

 

[bburl09]

I work as a dental assistant now, and will be starting dental school this summer. The dentist I work for has a style that's different from any other dentist I have observed or worked with. I know it won't be available in dental school, but he uses something called Sable Seek. I asked him one day about using an excavator to scoop out decay (I've seen some dentists do this, and others use an explorer) and he replied that using an excavator increases the likelihood of causing a nerve exposure. Seek seems like a nifty product, and its supposedly pretty cheap.

 

[olive6]

the doc i shadowed uses "diagno-dent" which is basically a laser that gives a number for the level of demineralization- pretty cool! when it goes past a certain number range, time for a filling!

 

[Duriel]

the doc i shadowed uses "diagno-dent" which is basically a laser that gives a number for the level of demineralization- pretty cool! when it goes past a certain number range, time for a filling!

The problem with diagnodent is that is also picks up stains and thus has false positives.

 

[doc toothache]

It seems like the new breed of dental students are thought to have the strength of Clark Kent and the finesse of the Hulk.

 

[Duriel]

It seems like the new breed of dental students are thought to have the strength of Clark Kent and the finesse of the Hulk.

 

[tooth knockn]

I believe an explorer is necessary for carie detection or a endo explorer . What other instrument can't catch a weak area in the enamel !

X-rays can't really find small caries on surfaces.

And if you worried about transferring a germ/bacteria W/E! From one tooth to another then scaling teeth should be re analyzed !!!!!

 

[Duriel]

I believe an explorer is necessary for carie detection or a endo explorer . What other instrument can't catch a weak area in the enamel !

X-rays can't really find small caries on surfaces.

And if you worried about transferring a germ/bacteria W/E! From one tooth to another then scaling teeth should be re analyzed !!!!!

Did you not read my post?

 

[beannaithe]

I use it. Couldn't imagine my exam without one. If for nothing else, than patients EXPECT it to be used.

 

[iamgosu]

Did you not read my post?

I did, and since when did a few studies become definitive on how we should practice? Evidence-based dentistry requires the combination of clinical experience, literature review, and own personal preference.

If you do it without an explorer, that's fine, but since the time of GV Black, explorers have been used by dentists for over a century, and it's been pretty darn effective so far.

Sure, if you have terrible clinical skills you can jab the lesion till the tooth gets traumatized, but that would be huge negligence on the practitioner's behalf.

And if your explorer does find a non-coaleseced p+f that's non-carious, can just seal it with sealant.

 

[OhioDMD]

I have been using one since 1977. Its not the only method I use for caries detection. I use it along with what I see in the patients mouth, radiographs and patients complaints. Sometimes I use it to verify that radiolucencies are defects rather than digitally enhanced artifacts. I also use it to verify caries removal during restorative procedures.